Abstract:
INTRODUCTION:HIV-1 viral escape in the cerebrospinal fluid (CSF) despite viral suppression in plasma is rare [1,2]. We describe the case of a 50-year-old HIV-1 infected patient who was diagnosed with HIV-1 in 1995. Antiretroviral therapy (ART) was started in 1998 with a CD4 T cell count of 71 cells/ìL and HIV-viremia of 46,000 copies/mL. ART with zidovudine (AZT), lamivudine (3TC) and efavirenz achieved full viral suppression. After the patient had interrupted ART for two years, treatment was re-introduced with tenofovir (TDF), emtricitabin (FTC) and ritonavir boosted atazanavir (ATVr). This regimen suppressed HIV-1 in plasma for nine years and CD4 cells stabilized around 600 cells/ìL. Since July 2013, the patient complained about severe gait ataxia and decreased concentration. MATERIALS AND METHODS:Additionally to a neurological examination, two lumbar punctures, a cerebral MRI and a neuropsycological test were performed. HIV-1 viral load in plasma and in CSF was quantified using Cobas TaqMan HIV-1 version 2.0 (Cobas Ampliprep, Roche diagnostic, Basel, Switzerland) with a detection limit of 20 copies/mL. Drug resistance mutations in HIV-1 reverse transcriptase and protease were evaluated using bulk sequencing. RESULTS:The CSF in January 2014 showed a pleocytosis with 75 cells/ìL (100% mononuclear) and 1,184 HIV-1 RNA copies/mL, while HIV-1 in plasma was below 20 copies/mL. The resistance testing of the CSF-HIV-1 RNA showed two NRTI resistance-associated mutations (M184V and K65R) and one NNRTI resistance-associated mutation (K103N). The cerebral MRI showed increased signal on T2-weighted images in the subcortical and periventricular white matter, in the basal ganglia and thalamus. Four months after ART intensification with AZT, 3TC, boosted darunavir and raltegravir, the pleocytosis in CSF cell count normalized to 1 cell/ìL and HIV viral load was suppressed. The neurological symptoms improved; however, equilibrium disturbances and impaired memory persisted. The neuro-psychological evaluation confirmed neurocognitive impairments in executive functions, attention, working and nonverbal memory, speed of information processing, visuospatial abilities and motor skills. CONCLUSIONS:HIV-1 infected patients with neurological complaints prompt further investigations of the CSF including measurement of HIV viral load and genotypic resistance testing since isolated replication of HIV with drug resistant variants can rarely occur despite viral suppression in plasma. Optimizing ART by using drugs with improved CNS penetration may achieve viral suppression in CSF with improvement of neurological symptoms.
journal_name
J Int AIDS Socjournal_title
Journal of the International AIDS Societyauthors
Béguelin C,Vázquez M,Bertschi M,Yerly S,de Jong D,Rauch A,Cusini Adoi
10.7448/IAS.17.4.19745subject
Has Abstractpub_date
2014-11-02 00:00:00pages
19745issue
4 Suppl 3issn
1758-2652pii
19745journal_volume
17pub_type
杂志文章abstract:INTRODUCTION:Disruption in bone homeostasis with increased osteoclastic resorption may lead to osteoporosis. HIV tat has been found to increase differentiation of precursor cells into osteoclast (OC) (1). Presence of soluble HIV proteins in virally suppressed HIV patients on ART may drive a bone resorption phenotype. W...
journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
doi:10.7448/IAS.17.4.19724
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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abstract:INTRODUCTION:The clinical value of monitoring CD4 counts in immune reconstituted, virologically suppressed HIV-infected patients is limited. We investigated if absolute lymphocyte counts (ALC) from an automated blood counting machine could accurately estimate CD4 counts. MATERIALS AND METHODS:CD4 counts, ALC and HIV v...
journal_title:Journal of the International AIDS Society
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doi:10.7448/IAS.17.4.19680
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,随机对照试验
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journal_title:Journal of the International AIDS Society
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journal_title:Journal of the International AIDS Society
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pub_type: 杂志文章,meta分析
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,评审
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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journal_title:Journal of the International AIDS Society
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,评审
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更新日期:2021-01-01 00:00:00
abstract:: With the success of antiretrovirals and increased access to this lifesaving treatment, the life expectancy of people living with HIV has been substantially increased and, in many instances, is comparable to that of the general population. However, HIV infection, as well as its treatment, can cause physical, psycholog...
journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,随机对照试验
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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journal_title:Journal of the International AIDS Society
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abstract:INTRODUCTION:People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The ...
journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,评审
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,评审
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journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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更新日期:2014-11-02 00:00:00
abstract:INTRODUCTION:In 2012, the Supreme Court of Canada ruled that people living with HIV (PLWH) must disclose their HIV status to sexual partners prior to sexual activity that poses a "realistic possibility" of HIV transmission for consent to sex to be valid. The Supreme Court deemed that the duty to disclose could be avert...
journal_title:Journal of the International AIDS Society
pub_type: 杂志文章,评审
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abstract:INTRODUCTION:The 48-week interim analysis of the MODAT study showed that confirmed virologic failure (CVF) was more frequent in patients simplifying to ATV/r monotherapy compared to maintaining ATV/r-based triple therapy. The DSMB recommended stopping study enrollment but continuing follow-up of enrolled patients. We p...
journal_title:Journal of the International AIDS Society
pub_type: 杂志文章
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更新日期:2014-11-02 00:00:00